Bronwyn Everett

Academic engagement and disengagement as predictors of performance in pathophysiology among nursing students

Abstract Connecting students with learning activities to promote academic engagement has been a focus of higher education over the past decade, partly driven by an increasing rate of student participation in part-time employment, and a growing concern about the quality of the student experience. Using a prospective survey design, this study selected three elements of academic engagement (homework completion, lecture attendance, and study hours) and academic disengagement (part-time work), to identify predictors of academic performance in a pathophysiology subject in 126 second year nursing students. Homework completion emerged as the strongest positive predictor of academic performance, followed by lecture attendance; however, time spent studying was not a significant predictor of academic performance. Of concern was the finding that the amount of part-time work had a significant and negative impact on academic performance. Combining all elements of academic engagement and disengagement, and controlling for age and ethnicity, the multiple regression model accounted for 34% of the variance in the academic performance of second year nursing students studying pathophysiology. Results from these findings indicate the importance of active learning engagement in influencing academic success, and provide some direction for nursing academics to design effective learning approaches to promote academic engagement of nursing students.

Bandura's exercise self-efficacy scale: Validation in an Australian cardiac rehabilitation setting

BACKGROUND Despite the established benefits of cardiac rehabilitation (CR) in improving health outcomes for people with cardiovascular disease, adherence to regular physical activity at recommended levels remains suboptimal. Self-efficacy has been shown to be an important mediator of health behaviour, including exercise. OBJECTIVES To assess the psychometric properties of Banduras exercise self-efficacy (ESE) scale in an Australian CR setting. DESIGN Validation study. SETTING Cardiac rehabilitation. PARTICIPANTS One hundred and ten patients (Mean: 60.11, S.D.: 10.57 years). METHODS Participants completed a six-minute walk test (6MWT) and Banduras exercise self-efficacy scale at enrollment and on completion of a 6-week CR program. RESULTS Banduras ESE scale had a single factor structure with high internal consistency (0.95), and demonstrated no floor or ceiling effects. A comparison of ESE scores by distance walked on 6MWT indicated those who recorded more than 500 m at baseline had significantly higher ESE scores (Mean: 116.26, S.D.: 32.02 m) than those patients who only achieved up to 400 m on the 6MWT at baseline (Mean: 89.94, S.D.: 29.47 m) (p=0.044). A positive and significant correlation between the change in scores on the ESE scale and the change in the 6MWT distance (r=0.28, p=0.035) was seen. CONCLUSIONS The ESE scale was a robust measure of exercise self-efficacy over the range of patients attending this outpatient cardiac rehabilitation program. Interventions to improve self-efficacy may increase CR patients efficacy for regular physical activity.

Embedded academic writing support for nursing students with English as a second language

AIM This paper reports a study which evaluated a brief, embedded academic support workshop as a strategy for improving academic writing skills in first-year nursing students with low-to-medium English language proficiency. BACKGROUND Nursing students who speak English as a second language have lower academic success compared with their native English-speaking counterparts. The development of academic writing skills is known to be most effective when embedded into discipline-specific curricula. METHODS Using a randomized controlled design, in 2008 106 students pre-enrolled in an introductory bioscience subject were randomized to receive either the intervention, a 4-day embedded academic learning support workshop facilitated by two bioscience (content) nursing academics and a writing and editing professional, or to act as the control group. The primary focus of the workshop was to support students to work through a mock assignment by providing progressive feedback and written suggestions on how to improve their answers. RESULTS Of the 59 students randomized to the intervention, only 28 attended the workshop. Bioscience assignment results were analysed for those who attended (attendees), those randomized to the intervention but who did not attend (non-attendees), and the control group. Using anova, the results indicated that attendees achieved statistically significantly higher mean scores (70.8, sd: 6.1) compared to both control group (58.4, sd: 3.4, P = 0.002) and non-attendees (48.5, sd: 5.5, P = 0.001). CONCLUSION A brief, intensive, embedded academic support workshop was effective in improving the academic writing ability of nursing students with low-to-medium English language proficiency, although reaching all students who are likely to benefit from this intervention remains a challenge.

Learning strategies of first year nursing and medical students: A comparative study

BACKGROUND Interprofessional education (IPE), where two or more professions learn with, from, and about each other to improve collaboration and the quality of care, has been proposed as a curriculum strategy to promote mutual understanding between professions, thus helping to prepare health professionals to work in challenging contemporary health systems. Although there is support for IPE initiatives within health professional education, differences in student motivation and learning strategies are likely to contribute to the success of these initiatives. OBJECTIVE To explore self-regulated learning strategies used by first year medical and nursing students, and to determine if these strategies were different among nursing students who were high achievers. DESIGN A comparative survey design. SETTING Nursing and medical nursing schools in a large university in the western region of Sydney, Australia. PARTICIPANTS Six hundred and sixty-five first year nursing (n=565) and medical (n=100) students in a large university in the western region of Sydney were surveyed to assess motivational and learning strategies using The Motivated Strategies for Learning Questionnaire (MSLQ). Data relating to sociodemographic characteristics and academic performance were also collected. RESULTS Nursing students were significantly older than medical students (mean age: 24.4 years versus 19.4 years; p<0.001), and there were also more females in the nursing student group (82% versus 56%; p<0.001). Although nursing students had a higher mean score for extrinsic goal orientation compared to medical students (p<0.001), medical students had higher mean scores for the other four learning strategies measured: peer learning (p=0.003), help seeking (p=0.008), critical thinking (p=0.058), and time and study environment management (p<0.001). Similarly, the grade point average (GPA) of medical students at the end of their first year was significantly higher (4.5, S.D. 1.4 versus 3.6, S.D. 1.3; p<0.001) compared to that of nursing students. CONCLUSION While interprofessional education is seen to have many benefits for students, this study demonstrates differences in motivational and learning strategies between nursing and medical students that may impact on the success of interprofessional programs.

Pragmatic insights into a nurse-delivered motivational interviewing intervention in the outpatient cardiac rehabilitation setting

PURPOSE Despite an increasing interest in motivational interviewing as a strategy to facilitate behavior change in people with cardiovascular disease, its use in cardiac rehabilitation (CR) appears minimal. Therefore, it is unclear whether the clinical method of motivational interviewing requires modification for the CR population, in which it could be argued that people are motivated and engaged. The purposes of this report are to describe processes in incorporating motivational interviewing in the CR setting and to discuss insights gained regarding the use of this intervention. METHODS As part of a randomized controlled trial currently recruiting in the CR setting, patients allocated to the intervention group participate in 2 motivational interviewing sessions with a motivational interviewing-trained nurse. To ascertain treatment fidelity, this process review comprised 3 sources: (1) the extant literature on motivational interviewing, (2) reflections of the project team, and (3) data derived from audiotaped interviews. RESULTS Key observations reflect that the motivational interviewing technique is well received, with patients appreciating the opportunity to “tell their story.” Preliminary qualitative data revealed that patients rate “health” and “family” as their most important values, with many commenting on their recovery phase as a “second chance.” CONCLUSIONS This report demonstrates that motivational interviewing is potentially useful and has significant promise in the CR setting. Discussion of pragmatic considerations as well as outcome data should assist clinicians in implementing this model of intervention in the CR setting.

Medication adherence self-report instruments : implications for practice and research

Background: After an acute cardiac event, adhering to recommendations for pharmacologic therapy is important in achieving optimal health outcomes. Considering the impressive evidence base for cardiovascular pharmacotherapy, strategies for promoting adherence are less well developed. Furthermore, accessing reliable, valid, and cost-effective mechanisms of monitoring adherence in the research and clinical settings is challenging. Aim: The aim of this article was to review published self-report measures assessing and monitoring medication adherence in cardiovascular disease and provide recommendations for research into medication adherence. Methods: The electronic databases CINAHL, Medline, and Science Direct were searched using the key search terms medication adherence and/or compliance, cardiovascular, self-report measures, and questionnaires. The World Wide Web was searched using the Google and Google Scholar search engines, and reference lists of retrieved documents were reviewed. The search strategy was verified by a health librarian. Instruments were included if they specifically addressed medication adherence as a discrete construct rather than a disease-specific or a generic health status measurement. Findings: Despite of the problems with medication adherence identified in the literature, only 7 instruments met the search criteria. There was limited use of instruments across studies and settings to enable comparison across populations and extensive psychometric evaluation. Conclusions: Medication adherence is a complex, multifaceted construct dependent on a range of physical, social, economic, and psychological considerations. In spite of the importance of adherence in ensuring optimal cardiovascular outcomes, conceptual underpinnings and methods of assessing medication adherence require further discussion and debate.

An intervention to promote physical activity and self-management in people with stable chronic heart failure The Home-Heart-Walk study: study protocol for a randomized controlled trial

BackgroundChronic heart failure (CHF) is a chronic debilitating condition with economic consequences, mostly because of frequent hospitalisations. Physical activity and adequate self-management capacity are important risk reduction strategies in the management of CHF. The Home-Heart-Walk is a self-monitoring intervention. This model of intervention has adapted the 6-minute walk test as a home-based activity that is self-administered and can be used for monitoring physical functional capacity in people with CHF. The aim of the Home-Heart-Walk program is to promote adherence to physical activity recommendations and improving self-management in people with CHF.Methods/DesignA randomised controlled trial is being conducted in English speaking people with CHF in four hospitals in Sydney, Australia. Individuals diagnosed with CHF, in New York Heart Association Functional Class II or III, with a previous admission to hospital for CHF are eligible to participate. Based on a previous CHF study and a loss to follow-up of 10%, 166 participants are required to be able to detect a 12-point difference in the study primary endpoint (SF-36 physical function domain).All enrolled participant receive an information session with a cardiovascular nurse. This information session covers key self-management components of CHF: daily weight; diet (salt reduction); medication adherence; and physical activity. Participants are randomised to either intervention or control group through the study randomisation centre after baseline questionnaires and assessment are completed. For people in the intervention group, the research nurse also explains the weekly Home-Heart-Walk protocol. All participants receive monthly phone calls from a research coordinator for six months, and outcome measures are conducted at one, three and six months. The primary outcome of the trial is the physical functioning domain of quality of life, measured by the physical functioning subscale of the Medical Outcome Study Short Form -36. Secondary outcomes include physical functional capacity measured by the standard six minute walk test, self-management capacity, health related quality of life measured by Medical Outcome Study Short Form -36 and Minnesota Living With Heart Failure Questionnaire, self-efficacy and self-care behaviour.DiscussionA self-monitoring intervention that can improve individuals exercise self-efficacy, self-management capacity could have potential significance in improving the management of people with chronic heart failure in community settings.Trial RegistrationAustralian New Zealand Clinical Trial Registry 12609000437268

Beyond the ceiling effect: using a mixed methods approach to measure patient satisfaction

Abstract This study reports patient satisfaction with the nursing care on a neurosurgical critical care unit. A modified version of the Ludwig-Beymer Patient Satisfaction Questionnaire (PSQ-7) was used, and included structured items and semi-structured interview questions. Data were collected from 149 patients. Participants rated their satisfaction as high (Mean = 25.14; SD = 2.96). The distribution of scores was skewed and every item demonstrated a ceiling effect. Principal component analysis yielded a one-component solution which explained 48% of the variance. NVivo® was used to match PSQ-7 scores with qualitative data. Participants’ comments were categorised as positive, negative or ‘yes, but’. Just over half the patients made positive comments and 29% of patients in the low group made negative comments. Three categories: ‘communication’, ‘nursing care delivery’ and ‘the hospital environment’ emerged from the qualitative data. A mixed method approach enables researchers to move beyond the ceiling effect of quantitative measures of patient satisfaction and to gain a more meaningful explanation of patient satisfaction.

Perception of cardiovascular risk following a percutaneous coronary intervention: a cross sectional study.

BACKGROUND An individuals perception of the risk of, and their susceptibility to, future cardiovascular events is crucial in engaging in effective secondary prevention. AIM To investigate the perception of a cardiovascular event by examining the level of agreement between individuals with CHD views of their actual and perceived risk. METHODS This study examined the individuals perception of the risk of a subsequent cardiac event among 220 patients hospitalised for a percutaneous coronary intervention (PCI) at a metropolitan, tertiary referral hospital in Sydney, Australia. Baseline clinical and demographic characteristics were collected, and actual risk (Personal Risk Score) calculated based on the presence or absence of nine cardiovascular risk factors: diabetes, hypertension, high cholesterol, cigarette smoking, previous history of CHD, family history of CHD, depression, overweight or obesity, and physical inactivity. Perception of risk was determined using an investigator-developed 4-item, 11-point Likert scale instrument (Perceived Heart Risk Questionnaire--PHRQ) which measured two dimensions of health threat: perceived seriousness, and perceived susceptibility. The correlation between the Personal Risk Score and the PHRQ was assessed using the Pearson product-moment correlation coefficient. RESULTS The calculated mean Personal Risk Score was 4.63±1.71 and the PHRQ was 25.5±7.04. The correlation between the Personal Risk Score (actual risk) and the PHRQ (perceived risk) was r=0.26 (p<0.01). CONCLUSIONS The weak relationship between actual and perceived risk is of concern, particularly in a population at higher risk for future cardiovascular events. Implementing strategies to personalise risk should be explored to improve the accuracy of risk perception, and facilitate tailoring of behaviour change strategies.

Self‐efficacy: a useful construct to promote physical activity in people with stable chronic heart failure

AIM To explore the conceptual underpinnings of self-efficacy to address the barriers to participating in physical activity and propose a model of intervention. BACKGROUND The benefits of physical activity in reducing cardiovascular risk have led to evidence-based recommendations for patients with heart disease, including those with chronic heart failure. However, adherence to best practice recommendations is often suboptimal, particularly in those individuals who experience high symptom burden and feel less confident to undertake physical activity. Self-efficacy is the degree of confidence an individual has in his/her ability to perform behaviour under several specific circumstances. Four factors influence an individuals level of self-efficacy: (1) past performance, (2) vicarious experience, (3) verbal persuasion and (4) physiological arousal. DESIGN Discursive. METHODS Using the method of a discursive paper, this article seeks to explore the conceptual underpinnings of self-efficacy to address the barriers to participating in physical activity and proposes a model of intervention, the Home-Heart-Walk, to promote physical activity and monitor functional status. CONCLUSIONS Implementing effective interventions to promote physical activities require appreciation of factors impacting on behaviour change. Addressing concepts relating to self-efficacy in physical activity interventions may promote participation and adherence in the longer term. RELEVANCE TO CLINICAL PRACTICE The increasing burden of chronic disease and the emphasis on self-management strategies underscore the importance of promoting adherence to recommendations, such as physical activity.